Kunze Klaus
Neurologische Universitätsklinik Hamburg - Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
J Neurol. 2002 Sep;249(9):1150-9. doi: 10.1007/s00415-002-0869-z.
Metabolic encephalopathies, usually multifactorial in origin, may be important complications of many diseases of patients treated in a critical care unit. In many cases these complications arise from more than one cause. Neurological signs of metabolic encephalopathies, ancillary tests and differential diagnosis, etiology and pathophysiology are discussed. In this context major single causes for metabolic encephalopathies are referred to. Metabolic encephalopathies as diseases per se (e. g. Wernicke's encephalopathy) and encephalopathies as consequences of deteriorating known diseases (e. g. renal or hepatic diseases) and encephalopathies as complications in patients treated with other diseases in the ICU have to be differentiated. Encephalopathies are known to be the most common complication of a large group of diseases treated in the ICU; on the other hand, manifestation of metabolic encephalopathy can be taken as a warning of deterioration or beginning organ dysfunction. So it would be misleading so far to reduce the clinical concept of metabolic encephalopathies in ICH to septic encephalopathy only.
代谢性脑病通常由多种因素引起，可能是重症监护病房中许多患者疾病的重要并发症。在许多情况下，这些并发症由多种原因导致。本文讨论了代谢性脑病的神经学体征、辅助检查、鉴别诊断、病因及病理生理学。在此背景下，还提及了代谢性脑病的主要单一病因。必须区分作为独立疾病本身的代谢性脑病（如韦尼克脑病）、已知疾病恶化导致的脑病（如肾脏或肝脏疾病）以及重症监护病房中其他疾病患者出现的作为并发症的脑病。已知脑病是重症监护病房中一大类疾病最常见的并发症；另一方面，代谢性脑病的表现可被视为病情恶化或器官功能开始出现障碍的警示信号。因此，迄今为止，将重症监护病房中代谢性脑病的临床概念仅简化为脓毒症性脑病是具有误导性的。
